Most critically ill children require intensive care to restore their abnormal hemodynamics back to normal. Sedation forms a major part of patient management. For long time sedation is monitored using clinical scores which are subjective, intermittent and time consuming. The aim of this study is to compare clinical score (COMFORT score) with Bispectral Index Score (BIS), which is objective, continuous and easy to interpret, in order to validate the use of BIS in PICU.
The study was a blinded, prospective one carried out in a level 3 PICU in Mumbai. Thirty three patients requiring mechanical ventilation along with sedation, for various pathologies were enrolled. Patients having neurological pathology were excluded. Simultaneous BIS and COMFORT scores were obtained while patient was on sedation, and also 2 hours after stopping sedation. Of the 33 patients evaluated, minimum age was 2 months and maximum 18 years with mean age of 5.19 years. The BIS scores correlated well with COMFORT scores in all age groups except for in children less than 1 year. BIS scores were more reliable with deeper levels of sedation and showed inaccuracies when the children were fully awake. This observation has little clinical significance as the need for assessment is obviously absent when the child is fully alert. Thus, BIS provides a real-time, continuous, objective, simple and reliable quantitative measurement of the changes in the consciousness level of sedated as well as paralyzed patients on mechanical ventilators.